Dr. Viral Patel (Internal Medicine) needs a second opinion on this medical case.
65 year male with shortness of breath *Chief Complaints* C/O Shortness of breath since last 1 month. Progressive from NYHA 2 to 4. C/O Cough most of the times non-productive for last 2 months. C/O fever intermittent since last 1 month Weight loss of nearly 10 kgs in 2 months. *History* Smoker otherwise no comorbidities. *Vitals* Saturation 80% on air Heart Rate :- 120/min Temp 99.6f BP 90/60 *Physical Examination* Respiratory examination revealed Absent Air entry on left side *Investigations* ESR 80 CRP 69 Mild Leukocytosis Creatinine 2.4 HIV negative Sputum AFB n C&S negative Sputum Cytology revealed Atypical cells clusters highly suggestive of malignancy. *Diagnosis* PLAIN CT THORAX confirmed left sided Hydropneumothorax. Contrast was avoided due to altered renal function. Repeat scan has been planned after ICD insertion. *Management* ICD inserted on left side. Clinically patient has stabilised vitally. With FiO2 32% patient is maintaining saturation around 94-95%. Antibiotics, IV fluids n supportive therapy is ongoing. Further management has been planned as per follow up CECT with ICD in situ to confirm malignancy n manage accordingly.
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